Neurologic and Neuromuscular Pathophysiology of Pregnancy

Maternal cerebral blood flow increases during pregnancy due to a decrease in cerebrovascular resistance and an increase in internal carotid artery diameter. Cerebrospinal fluid (CSF) pressure does not change during pregnancy and remains low. Increased maternal intracranial pressure (ICP) occurs with pushing or creating a Valsalva maneuver during the second stage of labor. With the presence of asymptomatic paraspinal and/or intracranial tumors, neuraxial anesthesia could be administered after careful clinical and radiographic evaluations. It is typically safe to administer neuraxial anesthesia for patients with spinal cord stimulators if there is no expected mechanical interference with the device or wires.